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Non-compliance with vitamin and mineral supplementation protocols after bariatric surgery could lead to nutritional deficiencies and related health complications, according to two separate case reports presented at the American College of Gastroenterology’s (ACG) 77th Annual Scientific meeting in Las Vegas.

In the first case report, Dr Mustafa Huseini and colleagues from the Geisinger Medical Center, reported that although rare in developed countries, selenium deficiency may occur in individuals with chronic malabsorptive states such as patients with history of gastric bypass, and long term selenium-deficient parenteral nutrition.

“Selenium is an essential trace element that plays an integral role in normal myocardial function so supplementation may be beneficial for individuals who are at risk of low absorption, such as gastric bypass patients,” said Huseini. He described the case of a 39 year female who underwent gastric bypass seven years before presenting to the emergency department for evaluation of change in mental status, generalised weakness and several days of poor oral intake.

On initial evaluation patient was noted to be hypotensive and in mild respiratory distress. After two days of hospital admission, she developed respiratory and circulatory collapse requiring endotracheal intubation and mechanical ventilation. A 2D echocardiogram showed a left ventricular ejection fraction of less than 20%.

The second case report from researchers at the University of Missouri concerned a non-compliant patient who failed to maintain regular follow-up after undergoing bariatric surgery, leading to severe vitamin and mineral deficiencies.

The 38-year old female patient underwent Roux-en-Y gastric bypass surgery but had limited follow-up during the five years since her surgery, when she presented with several weeks of fatigue. She lost nearly 104lbs (47kgs) since her surgery and was poorly compliant with her vitamin and mineral supplements, according to co-investigator Dr Hazem Hammad.

“When she came in for medical care she was pale and had a slight soft ejection systolic murmur,” said Hammad, who noted that she had hemoglobin of 4.7g/dL and marked mineral and vitamin deficiencies, including low levels of Vitamin B12, Vitamin D, Zinc, and Iron.

After receiving counselling about the crucial benefits of long term follow-up and compliance with vitamin supplements, the patient was discharged to complete an intravenous iron supplementation treatment course and to follow up with a bariatric surgery multidisciplinary centre.

Two weeks following discharge she received additional counselling from her primary care physician and was given a handout that outlined vitamin supplementation following bariatric surgery along with written information that included how to obtain bariatric vitamins via website, phone and from pharmacies. Three months following discharge laboratory tests revealed an increase in haemoglobin to 10.8g/dL and an improvement in her vitamins and mineral deficiency status.

“The pre- and post-operative management of bariatric surgery patients is clearly multidisciplinary. United States guidelines define the primary team as comprising the bariatric surgeon, the obesity specialist and the dietician,” said Hammad. “Primary care physicians, however, have a significant role in managing and following these patients by providing crucial patient education and support as illustrated in our case.”

WebMD News from HealthDay
By Robert PreidtHealthDay Reporter

WEDNESDAY, July 3 (HealthDay News) — A link may exist between autism and bacteria in a child’s digestive tract, a small new study suggests.

Researchers analyzed gut bacteria in fecal samples from 20 children with autism and 20 children without the disorder. The children with autism had significantly fewer types of gut bacteria, which potentially could make them more vulnerable to harmful bacteria.

The study also found that children with autism had significantly lower amounts of three types of important gut bacteria.

Autism, a neurodevelopmental disorder that can range from mild to severe, affects social and communication skills.

The new study appears July 3 in the journal PLoS One.

“One of the reasons we started addressing this topic is the fact that autistic children have a lot of [gastrointestinal] problems that can last into adulthood,” study leader Rosa Krajmalnik-Brown, a researcher at Arizona State University’s Biodesign Institute, said in a university news release. “Studies have shown that when we manage these problems, their behavior improves dramatically.”

This type of research could lead to new ways to treat autism-associated gastrointestinal problems, and improve diagnosis, prevention and treatment of autism, the study authors said.

Previous research has shown that gut bacteria plays a role in a wide range of important functions, including digestion, controlling body weight, immune response regulation and the production of neurotransmitters that affect the brain and behavior.

Although this study showed a potential link between gut bacteria and autism, it did not prove a cause-and-effect relationship.